Provider Demographics
NPI:1144495532
Name:LARRY E. SCHUTZ, PHD, ABPP
Entity type:Organization
Organization Name:LARRY E. SCHUTZ, PHD, ABPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-351-4962
Mailing Address - Street 1:6703 CACTUS CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4501
Mailing Address - Country:US
Mailing Address - Phone:407-351-4962
Mailing Address - Fax:407-345-9765
Practice Address - Street 1:6001 VINELAND RD
Practice Address - Street 2:SUITE 116
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7829
Practice Address - Country:US
Practice Address - Phone:407-351-4962
Practice Address - Fax:407-345-9765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75828Medicare PIN